Chamber and committees

The information requested is not held centrally by the Scottish Government.

The Scottish Government has not conducted any specific studies to monitor whether the current GP contract has resulted in a widening disparity between remote and rural healthcare provision and urban healthcare provision, however we have well-established reporting arrangements in place at the national level to monitor implementation of the GP contract by HSCPs. These reporting arrangements allow us to gain both quantitative and qualitative information on progress.

The National Performance Framework Quality of Care Experience indicator measures people’s rating of the overall care provided by their general practice over time, including a breakdown by urban/rural classification.

The 2018 GP contract included a programme of service redesign to ensure that arrangements for GP services better met the needs of the whole system and the needs of communities; it makes no new requirements of remote and rural GP practices. The 2018 GP contract is intended to reduce current risks to practice stability and sustainability by addressing some of the key risk factors relating to rising workload, premises and employment of staff. This in turn intended to make the partnership model more attractive to newer generations of GPs.

The Scottish Government established the Remote & Rural Working Group chaired by Professor Sir Lewis Ritchie in response to the concerns of rural GPs about the 2018 contract. The group produced the Shaping the Future Together report in January 2020 and various actions were undertaken as a result.

The Scottish Government is aware of the unique needs of our rural and islands communities, and that these needs vary significantly from place to place. We recognise that there is no “one size fits all” approach which will work for every community, and that harnessing the local knowledge of staff working within these areas can play an important role in improving healthcare outcomes.

That is why the work of the NHS Scotland remote, rural and islands task and finish group that we have convened is being led by representatives from across our rural and island Health Boards.

The group is working to develop a framework for sustainable delivery of healthcare services in rural and island communities. We aim to develop a model with services provided as local as possible and specialised as necessary in order to ensure equity of outcomes. The leadership, collaboration and innovation that our rural and island Board representatives are bringing to this group will ensure this work meets the needs of the communities they serve.

The Scottish Government has provided £168k funding since 2021 to Scottish Agritourism to assist with supporting the delivery of Scotland’s Agritourism Growth Strategy, broken down as follows

2022-23 – £35,000

2023-24 – £35,000

2024-25 – £98,000

While the Scottish Government provides the overarching guidance/framework for patient travel expenses reimbursement, NHS Boards are responsible for developing local policy to best meet the needs to their populations, and for assessing eligibly for financial support and level of that support. The cost of reimbursement is met from Boards’ budgets and all Boards must balance value for money with patient need, ensuring that patients are supported in identifying and accessing available support and that patient care is at the centre of all decisions.

The Scottish Government has committed to a review of the overarching patient travel expenses reimbursement guidance. However, a start date for the review is not confirmed at this time; it is important that the review is considered within the context of wider reform on access to health care.

It is recognised that transport to health is a key enabler to ensure equitable access to healthcare, and work to bring travel/transport and health planning closer together is in progress. This work will include bringing local bodies together at a regional level to consider the options for transport to health. This work will also inform how and when a review of the overarching patient travel expenses reimbursement guidance is taken forward.

The Scottish Government is working closely with NHS Education for Scotland (NES), to identify and deliver training opportunities for health and social care workers in rural and island areas. Through the National Centre for Remote and Rural Health and Care, housed within NES, 30 practitioners have undertaken the MSc in Rural Advanced Practice in 2023 and 2024, supporting career development, increasing equity in education and supporting the sustainability of primary healthcare services. The Centre will continue to develop new rural specific recognised qualifications to address skills gaps and drive innovation.

We are currently funding a dedicated resource in NES to scope the current skills landscape and identify where earn as you learn programmes could be expanded and where further development work is required with the aim of widening the pathways into health and care careers.

The Open University already provides distance learning Nursing degree education, which is accessed by Healthcare Support Workers already employed by NHS Boards, enabling them to train in their local area and continue to work.

Further, work is being explored via the Allied Health Professional and Healthcare Science education reviews’ recommendations and the Nursing and Midwifery Taskforce on how best to diversify the delivery and flexibility of education programmes.

The following table provides the number of practices which have held General Medical Services contracts (sometimes called 17J practices due to the relevant clause in the National Health Service (Scotland) Act 1978) in NHS Highland, NHS Western Isles, NHS Orkney, NHS Shetland, and NHS Grampian for each year since 2018.

Table 1 - Practices with General Medical Services contracts

The NRAC formula is an objective measure of the need for health care services across Scotland.

Under the existing formula the additional cost of providing health services in remote and rural areas is factored within one of the key components in determining funding allocations, with the formula giving greater weights to areas where there is evidence of unavoidable excess costs of supplying healthcare services.

The Scottish Government have committed to continually review the funding formula. This process is managed by the Technical Advisory Group for Resource Allocation (TAGRA) and supports vital work to reduce health inequalities; ensuring that we continue to allocate funding according to the relative need for healthcare in each Board area. Work is underway to review this, however, funding formulas are inherently complex and the review will take time.

The Scottish Government conducted an initial survey of residential rehabilitation providers in Scotland and published the results in November 2021. This showed that, at that time, there were 12 reported beds in Highland and 6 in the Western Isles. None were reported in Orkney, Shetland or Grampian.